Trends and Race/Ethnic Disparities in Diabetes-Related Hospital Use in Medicaid Enrollees: Analyses of Serial Cross-sectional State Data, 2008-2017

• Type of Material: Article
• Authors: Puneet Chehal, Emory University; Tegveer S. Uppal, Emory University; Boon Peng Ng, University of Central Florida; Maria Alva, Georgetown University; Mohammed Ali, Emory University
• Language: English
• Date: 2022-11-16
• Publisher: SPRINGER
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2022
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1007/s11606-022-07842-5
• Title of Journal or Parent Work: JOURNAL OF GENERAL INTERNAL MEDICINE
• Volume: 38
• Issue: 10
• Start Page: 2279
• End Page: 2288
• Grant/Funding Information: MKA was partially supported by the Georgia Center for Diabetes Translation Research funded by the National Institute of Diabetes and Digestive and Kidney Diseases (P30DK111024).
• Keywords: Medicine, General & Internal; disparities; Health Care Sciences & Services; General & Internal Medicine; POPULATION; diabetes; ADHERENCE; ETHNIC DISPARITIES; OUTCOMES; Life Sciences & Biomedicine; HEALTH; Medicaid; MANAGED CARE; hospital use; DISEASE; RACIAL DISPARITIES; AMERICANS; IMPACT; Science & Technology
• Research Categories: Health Sciences, Nutrition; Health Sciences, Public Health; Sociology, Ethnic and Racial Studies

Abstract

Background: Race/ethnic disparities in preventable diabetes-specific hospital care may exist among adults with diabetes who have Medicaid coverage. Objective: To examine race/ethnic disparities in utilization of preventable hospital care by adult Medicaid enrollees with diabetes across nine states over time. Design: Using serial cross-sectional state discharge records for emergency department (ED) visits and inpatient (IP) hospitalizations from the Healthcare Cost and Utilization Project, we quantified race/ethnicity-specific, state-year preventable diabetes-specific hospital utilization. Participants: Non-Hispanic Black, non-Hispanic White, and Hispanic adult Medicaid enrollees aged 18–64 with a diabetes diagnosis (excluding gestational or secondary diabetes) who were discharged from hospital care in Arizona, Iowa, Kentucky, Florida, Maryland, New Jersey, New York, North Carolina, and Utah for the years 2008, 2011, 2014, and 2017. Main Measures: Non-Hispanic Black-over-White and Hispanic-over-White rate ratios constructed using age- standardized state-year, race/ethnicity-specific ED, and IP diabetes-specific utilization rates. Key Results: The ratio of Black-over-White ED utilization rates for preventable diabetes-specific hospital care increased across the 9 states in our sample from 1.4 (CI 95, 1.31–1.50) in 2008 to 1.73 (CI 95, 1.68–1.78) in 2017. The cross-year-state average non-Hispanic Black-over-White IP rate ratio was 1.46 (CI 95, 1.42–1.50), reflecting increases in some states and decreases in others. The across-state-year average Hispanic-over-White rate ratio for ED utilization was 0.67 (CI 95, 0.63–0.71). The across-state-year average Hispanic-over-White IP hospitalization rate ratio was 0.72 (CI 95, 0.69–0.75). Conclusions: Hospital utilization by non-Hispanic Black Medicaid enrollees with diabetes was consistently greater and often increased relative to utilization by White enrollees within state programs between 2008 and 2017. Hispanic enrollee hospital utilization was either lower or indistinguishable relative to White enrollee hospital utilization in most states, but Hispanic utilization increased faster than White utilization in some states. Among broader patterns, there is heterogeneity in the magnitude of race/ethnic disparities in hospital utilization trends across states.